| Response of chronic cough to acid-suppressive therapy in patients with gastroesophageal reflux disease. | |
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MedLine Citation:
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PMID: 23117307 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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ABSTRACT BACKGROUND: Epidemiological and physiological studies suggest an association between gastroesophageal reflux disease (GERD) and chronic cough. However, the benefit of anti-reflux therapy for chronic cough remains unclear, with most relevant trials reporting negative findings. This systematic review aimed to re-evaluate the response of chronic cough to anti-reflux therapy in trials that allowed us to distinguish patients with or without objective evidence of GERD. METHODS: PubMed and Embase systematic searches identified clinical trials reporting cough response to anti-reflux therapy. Datasets were derived from trials that utilized pH-metry to characterize chronic cough patients. RESULTS: Nine randomized controlled trials of varied design that treated patients with acid suppression were identified (eight used proton pump inhibitors [PPIs], one used ranitidine). Datasets from two crossover studies showed that PPIs significantly improved cough relative to placebo, albeit only in the arm receiving placebo first. Therapeutic gain in seven datasets was greater in patients with pathological esophageal acid exposure (range: 12.5-35.8%) than in those without (range: 0.0-8.6%) with no overlap between groups. CONCLUSIONS: A therapeutic benefit for acid-suppressive therapy in chronic cough patients cannot be dismissed. However, evidence suggests that rigorous patient selection is necessary to identify patient populations likely to be responsive, utilizing physiologically timed cough events during reflux testing, minimal patient exclusion because of presumptive alternative diagnoses, and appropriate power to detect a modest therapeutic gain. Only then can we hope to resolve this vexing clinical management problem. |
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Authors:
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Peter J Kahrilas1; Colin W Howden1; Nesta Hughes2; Michael Molloy-Bland2 |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-11-1 |
Journal Detail:
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Title: Chest Volume: - ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2012 Nov |
Date Detail:
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Created Date: 2012-11-2 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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